Tuesday, May 12, 2015

E-mail Harassment From Anonymous Sources

Two or maybe even three years ago, I wrote a blog on the serious issue related to the use of Korean women as, possibly, involuntary providers of sex (comfort women) for Japanese soldiers during WWII. The issue has created a firestorm in the East as well as in Asian communities here in the US. No doubt it is for good reason because no one wants anyone from their culture (on either side) to be seen as this dastardly.

If it was done, it is truly horrific and I believe that one of the Japanese Prime Ministers did apologize for actions during WWII. Korean women, it would seem, weren't the only persons toward whom undeniably unspeakable acts were perpetrated. American soldiers were subjected to vivisection and that's something we need to remember, too. I'm not sure where you'd rate this on a scale of inhumanity, but I think it's at the top of it.  Cutting a living person open and then doing "experiments" on beating hearts and lungs, removing organs, etc. is more gruesome than even our worst horror movies. Hannibal Lecter, of course, comes to mind here.

My blog has touched a particularly sensitive nerve in someone in Japan and they are raining down incredibly long email assaults into my Inbox. What do they want me to do? I stopped reading after email number five or so because it was a constant harangue with supporting links. When I say these emails were long I am not exaggerating. They seemed to go on for pages.

Finally, in an attempt to stop this Yahoo mail user, I sent a note requesting some degree of civility from him and explaining that I'm not the person he needs to address his dialog to in the first place. What happened when I did that? You guessed it. It bounced back to me telling me that in .jp there is no such Yahoo account and the message was undeliverable.

Seems our man is using some sort of routine that will allow him to send out emails with a fake return email address to avoid getting harassed in kind for his missives. Clever but, if he truly wants to dialog, why hide who he is? I'm not going to bother giving this more thought because I've gotten a solution.

Do you use Google mail? Okay, then when you come across something like this, go to your Settings, create a Filter, Create Filter and check the box that indicates "Delete" these emails. Hopefully, I will never receive another of these again. Now it's wait and see time.

Wonder who else is getting these emails. I'll bet it's a bot that someone created and it's going out to hundreds, if not thousands of weary people who'd like some relief.


Saturday, May 9, 2015

Windows Is Confusing Me and I'm Concerned

The computer platforms wars have been raging for quite some time now and we've seen everything from Windows (multiple iterations) to Apple OS (also multiple iterations) to Linus (freeware) and I'm not sure about any other obscure platforms. But the one thing that is of great concern to me now is the shift from a simple computer purchase for an operating system to what Adobe is doing and Microsoft has begun to do; subscription services.

I want to be clear here. I'm not a big fan of subscriptions services that change the upgrades we've come to expect into subscription services we have to pay for monthly. Sure, it may come out to something like $200 a year, but let's think who's being left in the dust here.

CEOs, numbers crunchers and the rest of you appear to be seeing the market as one big consumer glob of people with ready cash and a thirst for yet more tweaks to your platforms. In this mode of rather constricted, in-the-box thinking, you are throwing a portion of the market overboard. Of course, I'm thinking of all those people out there who struggle to keep a computer in their homes for their kids and worry about the wi-fi bill or the elderly who more and more need computer access for homecare, ordering prescriptions and getting information that is vitally needed.

Switching out of Windows? May seem like a good idea to you as the right time to push on into that new technology that you are eagerly anticipating, but to me, I'm concerned about the little guys. But, perhaps, I'm being too much of a Nervous Nelly here.

In your heart-of-hearts you fully plan to keep offering support for things like Windows XP (doesn't business love this already and aren't they refusing to give it up?), Windows 7, and Windows 8. But for how long? Who knows, in this climate of change, when their computer just won't struggle, it won't work as well and then will come its demise. I should say this is abandonment because that's what it will be. Left in the dust again to, once more, be a cut-off population that has its lack of value stamped down hard on them.

Put yourself in the position of school kids in Mississippi or older folks in various parts of the country who were overjoyed when they actually got their hands on a computer. Sure it may have had to take a used one, but it worked, it actually worked and the wonders of the Internet were like discovering a whole new world of wonder. Comes the dawn and the undoing of all this wonder or the sudden need to pay for something that is unaffordable. A blow to them? No more like a tornado and all the dashed dreams that accompany it.

Am I reading this wrong? Are you going the Adobe route? There's a pick-and-choose menu of apps you may want, but it's at least $20 a month for each. Sure "One Adobe account, infinite possibilities" but, boys and girls, only if you can afford them. Tell me how many poor school systems that desperately need technology to get their kids up to speed in our technological age or elderly can fork over $20 a month for ONE app when they need three?

Oh, you have a whole package that sells for $49.95 a month. Do you know what that means? It is forget it time and dreams are dashed. Wonderful corporate move. Or are you going to make a special section for schools and the elderly? Why not a charitable section like that? Not in your corporate plans? Consider the PR you can get from it and the young new graphic designers you will be grooming and the medical consequences. You have a mighty PR advantage here. Are you going to use it? Smart move if you do

I was in a store yesterday that gave "student" and "military discounts" prominently displayed, but I didn't see "senior citizens" discounts. Yes, Ralph Lauren wrote them off for discounts. Probably thinks, wrongly so, that the older crowd doesn't wear jeans and shirts and sweaters, etc. Yes, they do Ralph and your people are being blatantly discriminatory. Don't you wear jeans and you're not exactly a spring chicken any longer, are you? Let's not forget your Brooklyn roots no matter how you've changed your name.

Windows has already made their move toward the subscription model, I know and I, for one, may be looking for another way to produce what I need not using Windows. Why should I pay for something I can get just as good for free. I love the Free Software Foundation and I think I should give it more attention in my tweets in the future.

The Internet used to be a wonderful, sharing place everyone could go to get things they needed (free) and help each other with projects. All of that help has been subsumed in "forums" set up on the sites of major developers. I have to tell you, I haven't always found the forums all that helpful, especially when it came to Apple and Canon. Yeah, I, like so many others, need "baby speak" when you explain how to do something. Get your experts to talk to real people on a regular basis. Even consider focus groups of new users.

What will we see in the End of Windows 10? I don't know, but I'm skeptical and I'm concerned. I root for the little guy and he/she seems to need a lot of rooting these days.


Wednesday, May 6, 2015

Moses and Baltimore Reconsidered

History, whether told through myth, manuscript or word of mouth, often contains one or more grains of useful insight, but you have to look carefully for them. The hidden bits of wisdom, applicable to what's happening in our world today, may provide a new appreciation of our culture or even guidance for all.

Thinking about the recent disturbances in Baltimore led me to wonder how our culture here in the United States or the rest of the world needs to change. Intolerance for the beliefs of others, discrimination against anyone who doesn't fit the currently acceptable ethnic standard and bias in general is abhorrent. Not everyone will agree because some will cling to the belief that they are superior to others and in keeping this one-up, one-down status quo, they will insure their importance if only in their own minds or those who share their beliefs.

As a family elder once told us, "They go to church on Sunday and talk disparaging about their neighbors on Mondays." A well-connected lawyer uttered a similar bit of wisdom to me. "I don't go to church because I'm religious. It's more of a business arrangement for me so it's important for me to be seen and to meet others who might be useful to me." Now the latter statement says it all.

When will there be meaningful change that will make the ugliness of Baltimore and Ferguson be bits of dishonorable history in the textbooks of the future? How will we achieve what everyone wants here in terms of equality in education, work opportunities, civil rights and the chance to live and prosper with their families? It didn't seem to be something that could be easily achieved. Perhaps Freud had the answer, in a way, if only people had read books other than his tracts on patient defense mechanisms.

Religion is quite interesting and religion and certain cultural history was something which latched onto the famous man's imagination. He wanted to answer one question for himself in "Moses and Monotheism" and it was why did the Jews wander for 40 years in the desert? Wasn't Moses familiar enough with the desert environment (he had lived there for a number of years) to lead his people directly to the Promised Land? Then, why would he deliberately, and it must have been deliberate, keep them in the desert before they finally came to the desired destination? One answer might lie in the fact that Moses may be more myth than reality. Was he a Jew or an Egyptian? Arguments exist on both sides of that question.

For Freud the answer lay in the experiences, the beliefs and even the biases of the people he was leading. Depending on what you read and how you are willing to interpret it, Moses either felt his charges were unworthy of the designated land or there was another, more important objective. The older generation, who held beliefs about others and themselves which were ill-suited for the new nation, had to be permitted to die off. The new place they would inhabit would be free of this psychological baggage and would start anew with a fresh perspective.

Do we have to wait for several generations to pass and for young ones to come along who will truly believe in equality and fairness for all? Remember that famous song about how bias and hate is spread? You put it into "their dear little ear" and they carry on the tradition. Hope in a younger generation may be misplaced. They may carry on what they have been taught. Salvation from the inequity, therefore, won't be so easily achieved.

Social media may provide a new means to achieve equality for all and it is here that the seeds of freedom may be sown if it is used with the best of intentions. The medium, however, is a supermarket of thought where hatred and goodness sit side-by-side. Teasing out what each bit of instant information has as its intent requires more than the short attention spans we've been led to believe are characteristic of our younger generation. Again, the problem area is apparent even here.  After all, it is available for everyone even those who would spew hatred and incite people to act irrationally against others.

Will we still have a new generation where people will refer to Native Americans as "filthy Indians?" Not if we work to remediate it.


Monday, May 4, 2015

Is the App the New News Breakthrough?

Scribes used to labor for years transferring the knowledge at hand laboriously into huge, beautifully illuminated manuscripts. There mission was simple; make it available for the ages and for the intellectuals who could read. A fine job was completed, especially in Ireland where they took on the task of saving all that could be saved from those who would obliterate and extinguish any ideas that existed in written form. Want to know more? Read "How the Irish Saved Civilization."

A bold invention, the printing press, saved the monks from years of labor and in so doing made literature and various forms of discourse readily available--but still only for those who could afford it. Books were a showy form of one's social standing but were probably read, too. The press also produced, in the United States, the initial broadsides that would quickly alert the colonists to how British rule as affecting their lives. Ultimately, we have to see it as the instrument that helped fire up the American Revolution and make this national rise from a colony to a country.

Cameras, men and women with the fortitude and dedication to reporting the news from the battlefront and from home, were the next technological advance that would bring change. Who can forget those iconic photos of people like Matthew Brady, Alexander Gardner, Robert Capa, and Dorothea Lange. They brought wars and community privation into our homes so that we became more fully informed citizens. It was an awakening thanks to technology, bravery and creativity.

Television and streaming video thanks to Internet connections from far afield made it possible to imbed photojournalists and media mavens in the fields of current conflicts. First the Vietnam war came into our living rooms each night and then the combat zones of the Middle East. It was news, but of course edited to fit the time slot and the slant.

Breaking away from the more traditional, and likely funded forms of journalism, technology has  given a quantum leap to news coverage thanks to cell phones with extraordinary apps. Citizen journalists or just concerned people viewing injustice or crime has given pause to many who acts with impunity before.

Now, in the latest political campaigns that are heating up, politicians will, like never before, be faced with the harsh reality of their poorly thought out statements. This is instantaneous, widespread, unadulterated coverage that will make some cringe and others will welcome the free coverage via the Internet. How will it affect the political climate? Only time will tell.

Even as I write, we are learning that a newer app, Snapchat, may turn things truly upside down for the politicians and the American people. It's not the first internet media to test its new teeth in a political campaign, but it may be the most jarring. Directed at over 100 million users, it is aimed at a younger, more emotionally charged audience that just could be willing to repeat the actions of their parents during the 60s when marchers filled the streets in vocal protest against what they saw as an unjust war in Vietnam.

Snapchat is both bewildering and fascinating in its new push toward content provided and pushed out by people on the street as well as in-studio journos. Sure it may be a bit disjointed at first, but as it gathers steam (and it has billions of dollars with which to work) and expertise, its force will become evident. The scrambling by other social media is apparent as they attempt to respond to this latest incursion into the form.

Forget about Niki Minaj and think about something called a "geofence." It's where an area of coverage is designated and everyone, citizens on the ground as well as experienced reporters, can contribute to an instantly created media push on an issue. The cell phone is the new printing press and Gutenberg would have been floored by its power.

Long live the cell phone.


Sunday, May 3, 2015

Traffic Lights Tell It All

Neighborhoods in some parts of New York City and other major cities have extremely wide expanses of roadways. While these may seem to be symbols of how important they are to traffic flow (with a nod to Robert Moses in NYC, I suppose), they are also something else. They cut across communities where those on foot must try to run to the islands of safety in the middle, wait for a lull in the cars or a light change again, and then scurry to safety.

One roadway in a middle-class community in NYC, Queens Boulevard, has been deemed The Boulevard of Death or The Boulevard of Broken Bones. The boulevard runs through one of the major shopping centers in the borough and is the intersection for major subways lines and overburdened rail stations. As the borough experiences a new resurgence of growth, thanks to high rents in Manhattan and Brooklyn, so will it see many more pedestrians on the street.

Twelve lanes of traffic in many sections prevent easily crossing Queens Boulevard for even the most fleet of foot. Consider how the elderly in this area anticipate a crossing of this roadway. Hearts must begin racing at just the thought and then the true racing begins as they push their grocery carts or walkers to reach the other side. Too many never make it. Actually, it was supposed to be a freeway but WWII interfered with the plan. So, between 2003 and 2013, 36 deaths were reported on the boulevard statistics.

Traffic lights have been changed so that a few more seconds are provided for the dash across the huge expanse. The notoriety of the roadway, however, has given it a place in rough-and-tumble video games like Grand Theft Auto IV. Small shrines of plastic flowers or crosses can be found occasionally to mark someone unsuccessful run to the far side. Yes, they went to a far side, but not the one they have hoped for.

The small memorials are quickly scooped up lest they display a lack of government involvement in pedestrian safety. Doesn't look good for tourists, either or persons considering moving to the area. Imagine if you had a child who had to cross that road. You would shudder each time they ventured there or you would forbid them to cross without a vigilant adult. Even an adult is no guarantee they'll make it safely to one of the islands and complete the crossing in one piece.

But traffic lights stand for something else, too, and not only on Queens Boulevard. Too frequently much-needed lights are not installed in unsafe areas. Less affluent areas may have fewer than needed. What prompts the lights to be brought in? Think about it for a moment. The question is simple: How many kids or adults have to be killed or maimed by speeding cars before a light is installed? It's certainly no problem hooking up to the incredible grid that snakes beneath the asphalt so that shouldn't even be a consideration here.

How much is a life worth as opposed to the cost of a traffic light? Are traffic lights really, really expensive, say millions of dollars? Or do we devalue life in specific areas of this great city and wait for a lawsuit to spring into action? Anyone seeing my question would probably explode into paroxysms of anger at the thought of a suggestion of such callousness on my part. Pardon me, but it's not me being callous. Too often people or kids are hit by cars and the cases are cataloged in media stories time and time again and no action is taken.  I know, personally, of a grandmother who was trying to cross one of these intersections and she was hit by a car so hard that she was literally lifted out of her shoes. Yes, she died.

Concerned citizens (aka concerned mothers) shouldn't have to march with baby carriages, block interactions and try to rile up the media and everyone else to achieve safe crossings for all. When you consider that some of these roadways are the equivalent of speedways for reckless drivers, no one who is a thinking person can expect anything but tragedy to be the result. In some areas, the kids have to walk in the roadway because sidewalks are either missing or torn up.

Who is doing the inspections of the roadways? Yes, the infrastructure of major cities is in appalling condition and getting worse. A young couple was killed last week by a chunk of an overpass that fell into their car. Should we accept this in a time of serious unemployment where many could be helped to regain their dignity and provide safety for all?

Ah, but the end is nigh, dear readers because we've now been told that in 2018 The Boulevard of Death will be improved and made safer. Just how they'll do this hasn't been fully outlined. Okay, so you're on the job with Queens Boulevard, now how about Crossbay Boulevard and the raceway that has proven to be for people living in the near-beach communities? Will that receive some added attention?

Budget cuts always seem to enter into these good plans, don't they? Sort of like the current suicide hot line in NYC that the mayor's wife has been promoting while the mayor just recently cut the funding. Good intentions there, but someone didn't get the message about retaining funding, right? How did that happen with the two involved individuals engaging in nightly pillow talk? They don't talk? Who knows.

And, while I'm at it, how does the "Broken Windows" community policing program fit into it all? If we are concerned with maintaining lawfulness, shouldn't this extend to ticketing speeders, people who run red lights and fail to give way to pedestrians crossing the street? Isn't this part of the idea or are we only concerned with how property looks and how one act can theoretically bring on a barrage of lawlessness?

No, it's not such a stretch. A roadway where drivers repeatedly drive 5, 10, 15, 20 or more miles per hour over the speed limit with impunity is just as good a sign of disrespect for the law as a building left with broken windows. Stop looking up and start looking down to street level.

Should we turn that famous reminder, "Caveat emptor" (Buyer beware) into "Pedestrian beware?" I recall seeing a sign on a roadway fence in California that ran across a stretch of undeveloped land. It read, "Beware! You are about to enter the most dangerous area in the United States, the state highway system." Really, folks, it's not the highway system necessarily that's so dangerous.


Friday, May 1, 2015

No Reservations Are Safe Seemingly

Despair may have been part of the baggage they carried on that long, terrible trip forced march from their homelands to the desolate places called "reservations." Undoubtedly, that despair was inherited by a young generation who had not known their proud heritage, their language and their culture as it once had existed. All around them, they saw only the ravages of hopelessness, opportunism, alcoholism and early death. Escape seemed and may still seem impossible. The old saying, "You can take someone out of the country, but you can never take the country out of them" may have a cruel twist to it in their case.

We call them Indians because Columbus in his ignorance thought he had found the new route to the golden riches of the New World. They aren't Indians. They are Native Americans and we have failed them miserably as they are still under the rule of The Bureau of Indian Affairs. Indian Affairs? Should we even have a bureau for them unless it does something more than restrict what they can do? Don't we owe these wonderful people more than they have been given and shouldn't they be more than sports team symbols? What have we failed to learn from them and what scourge have we imposed on the entire nations that are held within the desolate lands where they live in poverty?

The Pine Ridge Indian Reservation is only one of many but it may hold a key to some of the inherent ills that our government has nourished.  Should you not be conversant with the horrendous history of American actions toward the native peoples, read about The Trail of Tears.  Native peoples were forced off their millions of acres of lands in Georgia, Tennessee, Alabama, North Carolina and Florida, land they had occupied for many generations. The forced march from their homelands would lead them to an inhospitable relocation and a bitterness that was only natural.

The trip of 1,200 miles, on foot and with many in chains, would result in 3,500 of the 15,000 Creeks and 5,000 Cherokee dying along the way while the remainder of the group struggled. Their lands would be quickly snatched up as a lucrative means of growing cash crops. 

Native peoples were treated like unwanted immigrants in their own land and dismissed as something akin to inferior or feeble-minded beings. A culture that revered the earth and its spirits had, over the centuries, developed healing arts as well as religious rituals. Even these were restricted until recently when the BIA revised its rules to allow for gathering of specific plants or foliage by native peoples for their cultural needs. Imagine having someone tell you that you couldn’t practice your religion because they held control over the herbs used in the ceremonies.

A foreign country has been created within the United States which controls this country's borders, its behaviors and its citizens. The youth within this country are governed by new regulations from the BIA whereby "the (existing) model will be updated to provide better federal guidance to tribes in an effort to insure proper respect for the rights and responsibilities of Indian juveniles arrested for alcohol or drug-related offenses and those of their parents, guardians or custodians." 

Seems the native people still require guidance even though the BIA admits that "Tribes know best what will work in their communities..." How do "tribes know best" if they require guidance from an outside governmental body that is managed by persons not from that tribal culture? Just curious to me. 

Who knows best here? And what do they know "best" about? How will the new Model Indian Juvenile Code work and what impact will it have--especially when they're still referring to the tribe as "Indian" and not Native Americans? The bias is so inculcated into the minds of those writing the new regulations that they don't even see how offensive this can be to Native Americans.

On the Pine Ridge Indian Reservation, 103 young members between the ages of 12-24 tried to kill themselves between this past December to March. Too many succeeded in their attempt and one of them was a 12-year-old girl. What would make a promising, bright young girl believe that death was better than life on this spit of land? 

Consider high unemployment, alcoholism, hunger, poverty and the violence that attends these factors and what do you have? It's not exactly a trip to Disneyland each day you get up in a dingy trailer you share with a large, downtrodden extended family. When they leave the reservation on any kind of trip, what do they hear? The New York Times article quoted one man who said his granddaughter heard herself being referred to as "filthy Indians." Wonder where that woman grew up and what she heard as a child that led her to utter this offensive comment.

Need mental health help on this reservation? You can, of course, get it if one of the six professionals can see you as they struggle to attend to 40,000 inhabitants living there. The deaths of the nine who succeeding in ending their lives and the reason for their desperation can never be pinpointed by a note, a phone call or any other communication. 

Oh, let's not forget that communication on the reservation may not be up to even 20th century standards. Some kids have never used a computer, who can afford Internet service (even if it were offered) and phones can be a luxury. I knew a student teacher who found a reservation library with no books, a "science" lab with no equipment save for a broken glass beaker and kids who refused to believe there was such a thing as an ocean to the west of where they lived.  Strangled puppies hung from trees and broken bottles littered the ground.  The young teacher was hit by harsh reality even before he set foot in a classroom there.

The United States if roiling with marches against racism, yet here's a group that has no marchers with signs calling for fair treatment. Shouldn't we want fairness for all? Doesn't everyone's life matter, no matter their color or ethnicity?


Thursday, April 30, 2015

The Doctor's Dead

A patient in a chemotherapy hospital ward looked forward to the regular therapy sessions with her therapist who always brought laughter, a ready hug when needed and inserted more than a ray of sunshine in an otherwise taxing stay. Despite the diagnosis and the possibility of a shortened life, the patient somehow felt that everything could be okay if she stayed positive and had this wonderful therapist as a guide in her life's journey. It was comforting and she was always there when needed.

After the patient left when her series of treatments were completed and she found herself once again at home, involved in life and striving to stay healthy, she decided another "touch-up" session would be a good thing. Calling the office for an appointment always seemed like such a natural thing and there was no apprehension about a session. Other patients weren't quite so sanguine in their approach to sessions, she knew, but this therapist was willing to work outside the lines. The hug, for instance, would never be acceptable to a more traditional therapist and laughter and joking usually wasn't the stuff of sessions, either. But not here. This was a place of more than therapy. There was an unspoken kinship.

The phone rang several times and then the connection was made. "I'd like to make an appointment," she fairly chirped. Silence. Not good, the patient, thought for one brief moment and then she heard the words she'd never expected. "I'm sorry, but the doctor died." The thud she felt was like a hammer to the heart. Dead? How could such a vibrant, joyful woman be dead? Accident? Sudden horrific illness? What?

Slowly, she explained how long she had seen the therapist and the woman on the other end understood. The therapist, she soon learned, was, throughout all those wonderful and enlivening sessions, fighting her own cancer battle and cancer had won. Obviously, there was a demarcation line even in these sessions and the therapist's impending death was not to be discussed or even hinted at. Anger could have been her reaction, but that would have negated and minimized the therapist's own sacrifice in the service she provided to this patient. The sessions were to address the needs of the patient, not the therapist.

How many of the healthcare professionals who treat us are struggling with their own illnesses or demons that will remain unknown to us? The statistics concerning physician deaths by suicide may provide a window for us. And the stats are eyeopening.

Every year, we're told, 400 physicians commit suicide and it's often a hidden statistic because obituaries and short death biographies in the journals often decidedly omit suicide as the reason for death. In some cases, it may be insurance considerations, but more likely there's a reluctance on the part of the medical community to shine a light on this topic. Better to keep the family safe from the shame of suicide, I suspect, is their main motive and to present the person in a favorable light.

The topic has come home to me in a rather circuitous manner.  Querying a physician, about a specific medical procedure, I was told that there was a superior physician who could have provided the treatment but he had died. How, I asked? A few moments of thinking and the physician told me, "It was suicide." When I returned home, I immediately did a Google search and read the local newspaper account of this brilliant man's life and ultimate death outside his home, in the snow. Suicide was the cause, but how he did it was left out.

What had driven him to this? As I did more research, I discovered that he not only pioneered a specific procedure, but he taught internationally, had recently opened a hospital in another country, remarried and was preparing for some major changes in his life. Still relatively young, he had years left to utilize his skills for the benefit of others. What happened? No one will ever know because the town newspaper was the only source with that one article. The gates of secrecy had closed forever on this man and his final departure from medicine.

Burnout in physicians is too often shrugged off as the mind-numbing workload and impossible brutality and bullying of senior staff (particularly of interns and residents) is seen as a weeding out process and nothing more. If that's so, I guess the two talented men who had just begun their residences in prestigious New York City hospitals and who had killed themselves, weren't able to cut the mustard. Wimps, perhaps? How callous of anyone to even think that.

The burnout rate in medical students has been estimated to be about 50% by graduation. What happens to burned out medical students? Many of them will continue on to complete their degrees, but how do they manage that? Some, as the young woman found dead in a major NYC hospital stairwell (she was featured on the school's admissions brochure), will use easily available drugs to keep up the pace and avoid sleep as well as tolerating the continuous bad behavior of house staff and attendings. I recall one student telling me that, while observing a surgery and standing on a small stool to view the procedure, the surgeon wheeled around and kicked the stool out from under her. A nurse saved her from falling on the instrument tray. Another told me that he returned home each day from medical school in tears because of the dreadful day he's just had. Every day.

Depression is found in physicians just as it is in the general population. In fact, 12% of males and 18% of female physicians suffer from it. What about medical students, interns and residents?  Once serious, deep and chronic depression fails to remit,  physicians are much more successful at suicide because of their knowledge of lethal methods. Is admitting to depression discouraged and even looked down on by members of the profession? Probably and there could even be the concern that it will damage a career or put an end to one that is just beginning.

Such a concern appears to match up very well with the military where help may be available but requesting it may lead to short-circuiting career advancement. Then, of course, there's impairment brought on by medication should that be needed. Who wants a surgeon with any cognitive impairment brought on by medication to operate in their hospital or on their patients?

Medicine, despite what many people might think, is not such a great field to pursue as a career, even if you do manage to jump through all the hoops needed to just get into medical school. Things have only gone downhill as more and more paperwork is required and office staffs are stretched and everyone from student to physician is required to do more in the same amount of time--a time that is often extended by lack of sleep.

Where are physicians heading and why are we experiencing a dire need for increased numbers of physicians in this country? They are opting out of medicine, retiring early and looking at sites like D.O.C. (the Drop Out Club) that offers entree into another field where they can use their medical expertise out of a medical setting.

Failure to enlighten all those in the field about suicide potential and burnout insures a ready supply of physician-related obits and young docs jumping off buildings or overdosing in hospital stairwells. Just imagine yourself in a situation of constantly being expected to provide all the answers to health-related problems without anyone ever recognizing your needs. It's more than overwhelming. When medicine has the highest rate of suicide, something is wrong and something must be done.

Physicians begin to heal thyself as a profession or we all suffer.


Wednesday, April 29, 2015

Mediterranean Diet Makes Brains Bigger?

The news is on professional sites and in the news media. Astounding evidence from a single study of a group in an upper New York City area appeared to indicate that adhering to the Mediterranean diet resulted in "bigger brains" and, apparently, a lower incidence of Alzheimer's. The study intrigued me especially since the media were almost shouting about "bigger brains" from the diet.

Bigger brains in older Manhattanites? Could that only be a good thing or was there something else here? Remember, if you have a bigger brain, doesn't that indicate something not necessarily good? Don't we try to avoid traumatic brain swelling (i.e. bigger brains)? There's only so much room in our packed craniums, so how could we manage bigger brains? Turns out the "bigger brains" terminology was all wrong.

What the researchers really found was that, in a non-demented sample (that's important here) there was less shrinkage or atrophy in this sample when measured with highly sophisticated imaging equipment. Atrophy is something that happens with normal aging, it seems, and doesn't necessarily mean you're headed for dementia, although that's what it sounds like, doesn't it?

Brain cell death begins even before birth and throughout our lives these cells sluff off like our skin cells. They are replaced and continue to grow. In fact there's a storehouse of stem cells just waiting to be called up to action in one of the several brain holes (okay, they're called ventricles) however, and exercise and learning appear to be two of the most exquisite means to get nerve cells to sprout even more.  Sounds really promising, so get out your treadmill or bike and go to it to keep those little cells on that trajectory to growth.

The most interesting thing about the recent study, however, wasn't the diet aspect. As one very well-known expert on Alzheimer's and dementia, Dr. David Knopman of the Mayo Clinic stated, the fact that those in the study were on this diet may not necessarily be the key to defeating Alzheimer's.

There are many more factors that need to be considered. For me, one of the factors missing in the study was that these were all non-demented individuals. I think that a better design would have compared those on the diet and those not on the diet and see which group may have had less atrophy and, more importantly, less cognitive impairment. Also, when did each individual start the diet?

The particular area of Manhattan where the study participants lived is heavily populated by one or two distinctive ethnic groups and that further limits what we can say about the results. Lifestyle, cultural differences, religious beliefs, socialization and other factors also need to be entered into our multiple regression formula here. I do assume that was the mathematical approach they took here. A diet heavy in fish and light on beef may be good for health, but it's not necessarily the determining factor in brain atrophy, neurogenesis or dementia. Stress remains paramount in everything. Did anyone measure the stress levels of this group or how community identity affected stress?

We've seen rather shocking brain imaging studies of a young girl who had a brain that was so deficient in cells that it was more like a ring of cells rather than a plump ball.  It could remind you of the neural ring found in the "brain" of earthworms that we had to dissect out in our college biology class. The study I saw indicated that the girl was functioning normally even though she had a major deficiency in brain mass. So, is mass the key here or can we function on less massive brains? Quite an interesting question to me.

Word to the wise: Question the studies. I know it's challenging for media writers to make some of them sufficiently news worthy, but let's not get so carried away that it's absurd when the actual study is reviewed.


Tuesday, April 28, 2015

Rehabing the Aging Brain: Fact or Fiction and Why Do It?

Everyone gets older, if they care for their health and manage their stress level. But as we grow older, what negative consequences await us? Are we going to become slower in our cognitive efforts and, consequently, less creative and less work worthy? These are not inconsequential things to consider and, considering the bias there is toward older workers, is everyone over 50 or 60 headed to be put out to pasture whether its financial or emotionally possible or not?

Too many workers in this age group are already being viewed as unsuited for our full-throttle technological age. Gray hair is, at all costs, to be avoided unless, of course, it's just that "hint of gray" that is acceptable. Is it going to continue to be "Gray go away?" time in corporate America and in the entrepreneurial area?

Toss all that experience, forget the mistakes they can help us avoid and go blindly ahead with that age cut-off for hiring or any work consideration. Send them all to that dim golden age we've promised and, in an age of conservative lack of social consciousness, who cares what happens to them?

Let them all fend for themselves. It's not our concern. We just need to concentrate on getting that new iWatch, working on ramping up ad income on mobile devices and slurping up the latest cuisine or alcoholic beverages we can get, plus grabbing all those red-soled shoes. What an age. What a statement about how crass and how poorly we manage. The talent is there, but we are blind to it.

Along comes the new class of reformers who will "save" us from this dismal fate. Well, perhaps not save, but create the illusion that, if we do something right now, we can turn the tide of fortune for ourselves. Although the methods being offered may have true benefit, how do we change the bias that will still exist? Therein lies the rub.

Older workers are the workhorses of the marginal income jobs. They are reliable, have an incredible work ethic, a sense of respect for authority and, most telling of all, they have few, if any, options. They have been corralled into an employment pasture that provides no exit gate to a better life or job. In time, what will happen to them and how will they cope?

Look at the growing alcohol sales in the older population. Surely, that's one indication of despair and not increased socializing. It's a means to contend with the subtle, hostile erosion of self-esteem.

Consider, too, the distressing incidence of suicide among the elderly. A woman in her 80s jumps from the terrace of a New York City high rise building. A couple is found in their bedroom with the car running in the closed garage. A man goes into a nursing home, shoots his wife and then himself. How often does this happen? No one wants to tout these sad instances, but we must all face the realities regarding why it happens. Lay some of the blame at the doorstep of our ageist culture.

The back story to all of this lies, of course, in a return to valuing all of our citizens, regardless of their age or ethnicity. We marvel when a hospitalized 14-year-old girl invents (thanks to the forethought of the hospital administration) a device to help kids with CF clean their nebulizers.

Great, but what about the older worker who demonstrates just as much creativity? Oh, yes, we marvel when a tidbit is provided on that because this is a person in the unemployable heap of humanity. Wunderkinds are touted, but the swelling group of elderly must stand silently by and hope for a menial job. They wonder, too. But they wonder how things got this wrong and they were so abandoned because they know they still have horsepower in them and you can teach an old dog new tricks.

How do you teach these old dogs new tricks? It starts early on, but it's still viable in middle age and approaching senior citizenship or even beyond. The basic ingredients are still there.  Simple things can be done to tune up that sluggish creativity after 25 years of age and open new neural areas of the brain--areas that hold promise, but only with specific work. Think about what is termed neuroplasticity.

Start with learning something new and challenging. How many times have I heard an older person express not just reluctance but something akin to fear about computers. Ever use a typewriter? Computers are no more frightening and they are just stupid machines that depend on software written by someone else. Learning to be computer literate is available at free local community programs, colleges and senior citizen centers or even corporate programs to enlist new, older employees.

Speak only one language? Learn a new one, no matter how difficult it seems at first. Recall how much effort learning to read was when you first entered school? Yes, it was difficult and you had to work at it and you succeeded.

Computer programming is another language and there are many simple languages (Python for one and Learn Python the Hard Way--my favorite) that are useful in today's business climate. These programs, many written to get kids easily involved into programming, are online and available free. Search for these free programs which you can take in your own time and can even download the videos to view later. It's there and it will start your brain power on a new path. It also begins a process of evaluation and questioning of information and projects that charges up your interest.

In medical school, they teach interns a simple mantra, "Watch one, do one, teach one." And it's a way to help your own learning. Once you begin to learn something, you teach someone else how to do it. The process brings up questions that help you to learn your area even better. Wonderful to help yourself and someone else.

You are sitting there waiting for what? For senility to come your way? Forget about it. Fight for your right to be a "brainful" person by working at it like you work on your muscles to keep from falling. This is the new gym that you take with you wherever you go and no one can take it from you once you've built it. Just like education, it's yours for life, so live it.